Healthcare Provider Details

I. General information

NPI: 1710616065
Provider Name (Legal Business Name): ADVANCED HEALTH & PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N MIDDLETOWN RD
MEDIA PA
19063-5505
US

IV. Provider business mailing address

248 SPRINGHOUSE LN
MEDIA PA
19063-5347
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-5600
  • Fax:
Mailing address:
  • Phone: 610-721-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN COULTER
Title or Position: NURE PRACTITIONER
Credential: CRNP
Phone: 610-721-0277